Common Reasons for Denial of Short-Term Disability Benefits
If you’ve filed a short-term disability claim, you might feel like the insurance company is giving you the runaround or mishandling your claim — and there’s a good chance you’re right. Insurers are fundamentally incentivized to deny, delay, and otherwise mishandle short-term disability claims so that they don’t have to pay out the benefits you deserve.
At Bryant Legal Group, we help people throughout Chicago and Illinois with their short-term disability claims. With decades of collective experience, we’ve seen almost every tactic and strategy that insurance companies use against claimants like you.
In this article, we will discuss some of their most common excuses for denying short-term disability claims and how you can fight back.
What Is Short-Term Disability Insurance?
Short-term disability benefits provide financial assistance when you are unable to work due to a medical condition, illness, or injury. Many employers offer these benefits as part of their employees’ compensation packages, covering some or all of the premiums. However, you can also purchase private short-term disability insurance.
Short-term disability insurance plans’ terms and conditions vary, so you’ll need to carefully review your most up-to-date Summary Plan Description (SPD) or Plan Document to understand them. However, most disability insurance plans define “disability” in one of two ways:
- Own occupation: You are disabled if you cannot perform the primary duties of your actual job.
- Any occupation: Your medical conditions prevent you from doing any work that you are reasonably suited for based on your training, qualifications, and experience.
Typically, it is easier to qualify for short-term disability benefits with an “own occupation” plan — although some insurance adjusters approach every claim with a great deal of skepticism.
However, simply meeting your short-term disability plan’s definition of disability doesn’t mean you will automatically qualify for benefits. These plans also contain a variety of other potential stumbling blocks, including:
- Waiting periods: Sometimes called “elimination periods.” You cannot receive short-term disability benefits until a waiting period expires, which can range from days to months.
- Pre-existing condition clauses: Many short-term disability plans place limitations on when they will cover pre-existing conditions.
- Exclusions and limitations: Short-term disability plans also might limit or deny coverage for certain medical conditions and injuries, such as self-inflicted harm and substance use.
You will likely receive short-term disability benefits only if you meet all of these complex requirements, which is why insurance companies deny so many disability insurance applications.
Why Did the Insurance Company Deny My Short-Term Disability Claim?
After a denial, short-term disability claimants are less likely to push forward and file an appeal. Many think an appeal isn’t worth the bother, assuming that they’ll quickly return to work and a steady income.
Additionally, short-term disability insurance adjusters know that many people will not pursue an appeal, so they deny legitimate claims hoping that you’ll fall into this category of open-and-shut cases.
However, under federal law, most adjusters must provide a rationale for denying a claim. At Bryant Legal Group, we frequently see the following justifications.
Your Short-Term Disability Claim Lacks Necessary Evidence
“Insufficient evidence” is one of the most common reasons for a short-term disability claim denial. Sometimes, disabled claimants mistakenly assume that the adjuster will order their medical records for them. Or, the insurer might deny your claim before you can obtain the necessary evidence.
When submitting a short-term disability claim, it’s best to submit all the evidence and documents that support your claim — and you should never rely on the adjuster. If your claim lacks supporting evidence, then you’re giving the insurer a reason to deny your benefits.
Unfortunately, obtaining this evidence (which might include statements from your doctors, opinions from vocational experts, and thousands of pages of medical records) can be extremely difficult. That’s why many people rely on a disability insurance lawyer for help.
Inconsistencies in Your Behavior and Statements
The insurance company will use any inconsistent statements you make (in communications with their agents, for example) and any inconsistent behaviors you display to justify a denial of your disability claim. In many cases, it will have employees or investigators track your social media profiles or conduct in-person surveillance to determine whether you are exaggerating your condition or otherwise misrepresenting the nature of your disabling condition.
It can be easy to take social media posts and activities out of context. For example, if you post on social media that you’re excited to play in a soccer game with friends, the insurer might use that information to deny your disability claim on the basis that your condition is not disabling. During that soccer game, however, you might have sat on the bench and cheered on your friends. Or, you might have played for the last few minutes and spent the next day recovering.
However, to refute the insurance company’s attacks on your credibility, you’ll need documentation and evidence that supports your claims.
They Can Rescind Your Coverage Due to “Misrepresentations”
When you apply for private short-term disability coverage, you typically are required to provide a series of disclosures outlining your current medical conditions, the names of your doctors, and other information. If you have misrepresented certain material facts on your original disability insurance application, or if you failed to include relevant information that might have influenced whether the insurer would have sold you insurance coverage, then it will argue that it is justified in denying benefits, as it can “rescind” coverage.
To challenge this type of denial, you’ll need to show that the missing or inaccurate information is immaterial to the insurance coverage. For example, if you simply entered incorrect contact information, that would not be a misrepresentation that is material to your insurance coverage.
You Have a “Partial Disability”
Many short-term disability insurance policies only pay benefits for total disability and do not offer residual benefits for partial disabilities — conditions that interfere with some (but not all) of the primary duties of your occupation. Therefore, the insurance company might try to avoid paying your claim by arguing that you’re capable of some (but not all) of your job duties.
Then, it will assert that you can delegate those limited duties to another employee for a temporary period until your condition resolves. Given the short-term nature of your disability, the insurer might claim that the delegation will not disrupt your career or reduce your income.
However, these are not typically winning arguments. Arguably, the insurer could deny every disability claim (long-term or short-term) because you could delegate specific duties to others. Your ability to delegate job duties should never be used to justify a denial.
Bryant Legal Group: Consult With One of Our Experienced Chicago Short-Term Disability Attorneys
Here at Bryant Legal Group, P.C., our attorneys understand that short-term disability insurance claimants might find themselves in a uniquely vulnerable position. If the insurer can find even the slightest justification, it will deny your short-term disability claim. Our lawyers work tirelessly to help our clients secure a favorable outcome — whether through a buyout or litigation.
Please call (312) 561-3010 or complete this brief online form to speak with one of the experienced Chicago short-term disability attorneys at Bryant Legal Group. During our discussion, we will evaluate your disability claims and help you develop an effective strategy for resolving your dispute. Your consultation is free, confidential, and comes with no obligation to retain our services.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.